I'm 26/M, in good health. Had a serious case of iritis this past May, but it was treated successfully with steroidal drops, and no hint of a return. Previously I have been told that I was not a good candidate for any form of lasik due to my prescription changing .25-.5 point year to year. My prescription was checked & changed in December '06, it had increased by .25 point in each eye. In May during the many visits to treat my iritis, my Rx was checked and rechecked with no apparent change (some fluctuation in left eye due to iritis, but after treatment Rx was back to Dec readings). My doctor informed me that in a few months if my Rx remained stable, that he would recommend lasik. I had mentioned that I was concerned because previously my Rx had always changed with-in a 12 month period. He mentioned that if that were the case, I should wait until December to get checked again and decide.

It's now January, I decided it was finally time, so I checked last week. My prescription was the same, the doctor said he tried to give me a stronger prescription and it just didn't take. He dilated my pupils and checked again, and confirmed my prescription was still stable. So, my doctor recommended that I get Lasik. I had him book the surgery for next week with their affiliate laser center. [a national Lasik chain] in Annapolis, md.

I have only limited information about [the national Lasik chain], and my understanding of how the process works is that all pre & post op care is done through my doctor. Only the wavefront scan and procedure itself are done through [the national Lasik chain].

Apparently the fee for me is $4800, and according to [the national Lasik chain]'s website the following information is given:

No two eyes are alike and [the national Lasik chain] recognizes that every refractive condition deserves the right technology. At [the national Lasik chain], we keep our focus on providing the safest and most advanced technologies to our patients.

LASIK is a two-step procedure that reshapes the middle portion of the cornea.

Step One: In order to get to this middle portion of the cornea, a flap must be created so this outer surface layer can then be moved aside. This flap is created with either the microkeratome surgical blade or the IntraLaseR laser. The IntraLase methos allows for an all-laser LASIK procedure also known as Bladeless LASIK. Click here to learn more.

Step Two: This step occurs when the laser actually treats (ablates) this middle portion, reshaping the eye for improved vision and a very rapid recovery time. The type of laser we use for Step two is:

* The VISX STAR S4 ActiveTrakT Excimer Laser System which is used to treat nearsightedness and farsightedness with or without astigmatism. It incorporates the VISX patented variable-beam technology with the new 3-D ActiveTrack eye tracker system that works without pupil dilation. This laser represents next-generation laser technology and reflects our continuing commitment to offer our patients high-quality treatment for each individual condition.

My Rx:

Left eye:

-5.25x-1.25 axis 150

Right eye:

-5.00x-1.25 axis 170

Pupils are between 5.5mm - 6mm in low light.

Looking for recommendations based on the above information, and some clues as to pricing guidelines so I know I'm not paying more than I should for the service.

The national chain you mentioned has a history of contracting with some of the nation's top surgeon, however your limited exposure to that surgeon also limits the amount of benefit you will receive from that surgeon. All peroperative and postoperative treatment will be provided by an optometrist.

This environmnet is called comanagment and it has both advantages and disadvantages. An advantage is that you get the opinions of two doctors with different training and expertise. The disadvantage is that the diagnosis and treatment of concerns and problems is not handled by the surgeon. Many people have comanaged Lasik without a problem. You need to decide if this is for you.

Your vision correction is within the approved parameters for Lasik, however I strongly recommend you consider a surface ablation technique like PRK, LASEK, or even Epi-Lasik as a possible alternative. These eliminate the Lasik flap and the possibility of any Lasik flap related complication. There are downsides, such as a slower vision recovery and more discomfort, but in the long term the vision outcome will likely be the same and you don't need to be concerned about a Lasik flap related complication during surgeon or for the remainder of your life.

I had spoken with my doctor about all laser lasik alternatives, and his position was that in his experience patients who had PRK had significantly more discomfort, swelling, and post surgery complications compared to flap based procedures. He seemed particularly unpleasant about the idea of using a contact as a bandage for PRK type procedures. However, he also pointed out that it is something I should discuss with the surgeon.

If I may ask, why do you recommend the other procedures? What are the possible complications of a flap? (Can't believe I actually need to ask that, it just sounds wrong...) Anyhow, I don't really have a lot of access to knowledgeable people regarding this, so any detail information you can provide would be most welcome.

Toastysoul wrote:If I may ask, why do you recommend the other procedures? What are the possible complications of a flap? (Can't believe I actually need to ask that, it just sounds wrong...) Anyhow, I don't really have a lot of access to knowledgeable people regarding this, so any detail information you can provide would be most welcome.

There are a number of complications that can occur with a Lasik flap. The most prevelent are striae, epithelial ingrowth, and diffuse lamellar keratitus (DLK). Several studies have shown Lasik to have a greater incidence of induced dry eye than surface ablations. All of these issues respond relatively well to treatment.

I do not raise these issues to frighten you or to specific target Lasik. The probability of a Lasik flap related complication is relatively low, however no possibility of a complication is almost always better than a low probability. It is at least something to consider as a part of your decision.

I was looking at some of my old boxes of contacts. About 2-3 yrs ago, my prescription was .5 diopters less in each eye than it is now. I'm not even certain that it actually was 2-3 yrs, because it could have just been a reordered box based on a script is 3+ yrs old. In any event, I was using those contacts up until December 05, and in Dec 06, my script read what it is now.

As I said before, over the course of this year, my script hasn't changed at all. Would that be a good indication that script is stable, or just taking a breather from changing?

There are many reasons why refractive error changes. Most relate to time of life and environmental issues. Different medications, prescription and over the counter, can change refractive error. Pregnancy and nursing (I know that does not apply to you) is a major reason for temporary changes in eye prescription. Fluctuation in eye hydration. There are some diseases for which vision changes are a symptom. Only a comprehensive exam from a competent eyecare doctor can provide any real insight (pun intended).

I went for my wavefront today, and after an ordeal to get there, I sit for about 10 minutes to fill out their paperwork and look over your 50 tough questions assessment only to find out that they require a 3 week waiting period from the last date of wearing my contacts to do the surgery. It was 2 weeks this week, and I was told by my Optometrist who booked the appointment, that 2 weeks was fine. I suppose this might be one of those hiccups you mentioned regarding co-managed care.

I'm starting to wonder if the co-managed approach is right for me. I have been reading in-depth about flap complications, and considering that if such a complication were to occur, who would I see? (pun also intended) Is my Optometrist equipped to deal with such a problem? If he is, that's good. Because his office is only about 2-5 minutes from my house, and they generally have evening hours (7pm). If he isn't, and I have to go 20-30 minutes out to the surgeon's office what then? Am I then expected to pay extra for treatment of the flap complication? It's leaves a lot of questions unanswered. I was told that all pre & post exams would be done through the Opt., but the procedure and wavefront scan would be done by [the national chain]. Not sure what to do at this point.

FYI, I was reviewing your questionnaire, there are a *lot* of good questions on there, but it seems to me that many would go unanswered, or even border on privacy violation (requesting contact information of patients). Is there a more condensed version that you recommend? I'm not so concerned about this doctor's criminal record, or about pregnancy complications (lol), but I would like to know percentages of success with similar procedures and Rx's. I'm not certain either how to approach the staff with the questions. I could be blunt about it, but TBH, I'm afraid it will cause more problems than it might prevent. What are your thoughts Glenn?

What we recommend is that the tough questions be sent to the doctor well in advance of your exam, or ask the doctor's office to download a copy directly. About half of the questions can be researched and answered in advance, with the other half specific to the patient's needs and only can be answered after a comprehensive examination.

There is some other information, which looks like my prescription, as the script above is slightly different than what I was tested at 3 weeks ago. Additionally, I did 3 tests before the wavefront, and I wasn't able to get copies of those. The person running the tests seemed to be rushing a little, and although she let me look at the results, I didn't get the impression she wanted me to keep copies, even of the tests that were disregarded because of misalignment of my eye. I asked her if I could have one to look at, and she promptly took it back before moving me into another room to wait to see another Dr.

The second doctor I talked to did a basic eye exam, though much less through than my typical Dr. She measured my pupils and discussed the procedure based on a check list she had in hand. I asked many questions, and after looking at a chart she mentioned that they would be taking 90 microns to make the flap. I asked about how much they planned to take to correct my eyes, and she said they could give me that information *after* the procedure. Not exactly the answer I was looking for... She did mention that she believed there would be more than enough room for an enhancement if one is warranted, and then went over the details to ensure what I would need to do to be covered by their "Lifetime Commitment" in case an enhancement is needed way down the road. I asked about flap complications, and what would be the proper procedure in case anything happened. She mentioned a 24hour number they'd give me for any problems, and that in the event of any flap related issues, I would return to the laser center rather than my standard Dr. They went over the fees, handed me two prescriptions to get filled. I found out the prices later and almost had a coronary (Restasis $700 :shock: w/o ins & Vigamox $75 w/o ins)!

They gave me a little zippered bag with some drops, eye shields, polarized sunglasses, and requested that I bring it with me the day of surgery. We discussed payment terms, then I was out. The whole process was about 2 hours.

I paid $3,700 here in Houston for mine. 100% blade free and surprisingly the cheapest I found out of the many places I went for consultations. Most places give you a "cash" discount, you can pay with a cashier's check or credit card, too.